A, Masamba Lived experiences and pathways to unsafe abortion among women and adolescents accessing post abortion care at selected hospitals in Lilongwe, Malawi
An interpretive phenomenological study.
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2024-07-28 
https://doi.org/10.14419/5n610p40
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Unsafe Abortion; Maternal Health; Post-Abortion Care (PAC); Sexual and Reproductive Health; Malawi -
Abstract
Every year, women and adolescents in the world seek abortion for unwanted pregnancies, with nearly half of these abortions being unsafe. Women and adolescents who suffer an unsafe abortion develop short and long-term complications. In Malawi, unsafe abortion is main cause of maternal deaths. At least 23% of all maternal deaths are due to complications of unsafe abortions.
Aim: To explore lived experiences, pathways, facilitators and barriers to unsafe abortion among women and adolescents accessing post-abortion treatment at selected hospitals in Lilongwe, Malawi.
Method: Phenomenological study design was used. Study population were women and adolescents who were receiving post abortion treatment at Bwaila Hospital and Kabudula Community Hospital respectively. 25 women who had unsafe abortion in the past four years were interviewed. Data was collected by in-depth and key informant interviews. Voice recorders were used. Verbatim was transcribed, translated into English and written in the note book. Atlas-Ti software version 8.0 was used for data analysis.
Results: Pathways to unsafe abortions included power relations, lack of knowledge of PMTCT, infidelity and fear of divorce and child spacing and family size. Facilitators of safe abortion services were: village clinics, establishment of bylaws in the community, introduction of sexuality education in primary schools, promotion of sexual reproductive health mobile clinics among others. Whereas barriers to safe abortions included, social, cultural, religious, physical and attitude barriers. Lived experiences included: sterility, anger, excommunication from the church, divorce, social effects, disability, depression, loss of learning, nightmares, suicide attempts, near-death illnesses, denial and stigma.
Conclusion: Increasing investment in post abortion care (PAC), creating awareness, and improve availability of sexual and reproductive health services can reduce the cases of unsafe abortion and its adverse consequences in Malawi and similar settings.
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References
- Iqbal Shah, Elizabeth Ashman, 2009. Unsafe Abortion: Global and Regional Incidences. Trends, Consequences and challenges. https://doi.org/10.1016/S1701-2163(16)34376-6.
- Haddad, LB. Nour, NM. 2009. Unsafe abortion: Unnecessary maternal mortality.
- Daire, J. et, al. 2018). Political Priority for Abortion Law Reform in Malawi.
- Jackson, E. et al., l 2011. A strategic assessment of unsafe abortion in Malawi: https://doi.org/10.1016/S0968-8080(11)37563-5.
- Odland, M. et al., 2018. The Use of Manual Vacuum Aspiration in the Treatment of Incomplete Abortions: A Descriptive Study from Three Public Hospitals in Malawi: https://doi.org/10.3390/ijerph15020370.
- Chan, Z.Y. et al., (2013. Bracketing in Phenomenology: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=phenomenology+study+approach&btnG=.
- Mkulichi, A. 2017. Unsafe Abortion, Its Determinants and Associated Factors: The Case of Malawi: A systematic Review: https://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1529&context=iph_theses.
- Mhango, C. 2017. Commentary: Proposed Termination of Pregnancy Bill: Doctors use what they have: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Mhango+C+commentary&btnG=. https://doi.org/10.4314/mmj.v29i1.17.
- Malawi Demography Health Survey (MDHS, 2015-2016): https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Malawi+Demographic+Health+Survey+2016+abortion&btnG=.
- Salomonsen, E. 2017. Unsafe abortion in legally restricted areas: How politics and laws decide women’s future: A literature review on the incidence of induced abortion and adverse health consequences in Sub Saharan Africa with restrictive abortion laws.
- Geubbels, E. 2006. Epidemiology of Maternal Mortality in Malawi.
- Roberts, T. 2013. Understanding the research methodology of interpretative phenomenological analysis: https://doi.org/10.12968/bjom.2013.21.3.215.
- Benson, J., et al., (2015. Costs of post abortion care in public sector health facilities in Malawi: a cross-sectional survey. BMC Health Services Research, 15(562). https://doi.org/10.1186/s12913-015-1216-2.
- Nyasa Times, 11 March 2021. Malawi: 'The Noes Have It' - Abortion Bill Miscarried as Malawi MPs Reject Its Tabling: https://allafrica.com/stories/202103120080.html.
- Babbie, E. 2005. The basics of social research. 3rd ed.
- ICW-Malawi, 2009: Unwanted pregnancy and abortion. Experiences of women in Malawi.
- Malawi UNFPA, 2017: https://malawi.unfpa.org/sites/default/files/resource-pdf/Malawi_National_SRHR_Policy_2017-2022_16Nov17.pdf.
- Mhango, C. 2015 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173639.
- Polis CB, Mhango C, Philbin J, Chimwaza W, Chipeta E, Msusa A (2017): Incidence of induced abortion in Malawi, 2015 https://doi.org/10.1371/journal.pone.0173639.
- Miller, C. 2021: Maternal Mortality from Induced Abortion in Malawi: What Does the Latest Evidence Suggest? https://doi.org/10.3390/ijerph181910506.
- Penfold, S., Wendot, S., Nafula, I. et al, 2018: A qualitative study of safe abortion and post-abortion family planning service experi-ences of women attending private facilities in Kenya. https://doi.org/10.1186/s12978-018-0509-4.
- Elamin, W. et al. 2018: A Qualitative Study Exploring Women’s Experiences of Unsafe Abortion in Sudan https://www.scirp.org/journal/paperinformation.aspx?paperid=74767.
- Guttmacher Institute, 2017: Abortion and Post abortion care in Malawi https://www.guttmacher.org/fact-sheet/abortion-malawi
- Netshinombelo, M., Maputle, M.S. and Ramathuba, D.U., 2022. Women’s Perceived Barriers to Accessing Post-Abortion Care Services in Selected Districts in KwaZulu Natal Province, South Africa: A Qualitative Study. Annals of Global Health https://doi.org/10.5334/aogh.3888.
- African Population and Research Centre, Rutgers, 2022. Lived experiences and pathways to abortion in Kilifi County, Kenya: https://rutgers.international/wp-content/uploads/2022/03/Final-Report-Kenya-APHRC-Rutgers.pdf.
- https://www.researchgatenet/publication/349486968_Lived_Experiences_of_Women_Who_Underwent_Induced_Abortion_A_qualitative_study_of_Rakai_District_Uganda.
- Oulman, E. et al, 2015. Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Ex-periences Survey: https://doi.org/10.1186/s12884-015-0663-4.
- Amaral, B. et al, 2021. Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises: https://www.frontiersin.org/articles/10.3389/fgwh.2021.699121/full.
- Nader, Blandino and Maciel (2007): Characteristics of hospital abortions in a public maternity in the municipality of Serra – ES https://www.researchgate.net/publication/262499483_Characteristics_of_hospital_abortions_in_a_public_maternity_in_the_municipality_of_Serra_-_ES.
- Bruyn, M. et al (2009). Unwanted pregnancy and abortion experiences in Malawi: http://www.icw.org.
- Major, et al. (2000). Abortion and Mental Health: Evaluating evidence https://www.apa.org/pubs/journals/features/amp-64-9-863.pdf. https://doi.org/10.1037/a0017497.
- Gan, Zou, Wu, Li (2008). The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome: https://www.ncbi.nlm.nih.gov/books/NBK75172/.
- Rees and Sabia (2007). The relationship between depression and abortion: https://pubmed.ncbi.nlm.nih.gov/17901849/.
- Kersting, Kroker, Steinhard et al. (2009). Psychological impact on women after second and third abortion: https://pubmed.ncbi.nlm.nih.gov/19266250/.
- https://books.google.mw/books?hl=en&lr=&id=luqgKK2euxoC&oi=fnd&pg=PR7&dq=health+systems+definition&ots=sNn50e5FPa&sig=BpdXcRRTB9Yh41jfIlJ9jbY0x3w&redir_esc=y#v=onepage&q=health%20systems%20definition&f=false.
- Owolabi, O. et, al (2019). Health systems' capacity to provide post-abortion care: a multicounty analysis using signal functions. https://www.sciencedirect.com/science/article/pii/S2214109X18304042. https://doi.org/10.1016/S2214-109X(18)30404-2.
- Angelica Sousa, Rafael Lozano, Emmanuela Gakidou (2010). Exploring the determinants of unsafe abortion: Improving evidence base in Mexico https://doi.org/10.1093/heapol/czp061.
- Banarjee, S. et al (2017). An exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India. https://doi.org/10.1186/s12913-017-2159-6.
- Chimatiro, C. et al (2020). The role of community leaders on adolescent’s HIV and sexual reproductive health and rights in Mulanje, Malawi. https://doi.org/10.21203/rs.2.21395/v1.
- Mutua MM, Manderson L, Musenge E, Achia TNO (2018) Policy, law and post-abortion care services in Kenya. PLoS ONE 13(9): e0204240. https://doi.org/10.1371/journal.pone.0204240.
- Kwigizile, E. et, al (2020) The relationship between women’s reproductive factors and household social economic status: The case of Morogoro district, Tanzania. https://academicjournals.org/journal/JASD/article-full-text/CE16C5864172
- Habarland, N. Rogow, D, (2015). Sexuality Education: Emegring Trends in evidence and practice. https://doi.org/10.1016/j.jadohealth.2014.08.013.
- Odland, M. et al (2021) Women Do Not Utilise Family Planning According to Their Needs in Southern Malawi: A Cross-Sectional Sur-vey https://doi.org/10.3390/ijerph18084072.
- Masamba, A. (2016). Using pupils to save lives of mothers and babies in Mchinji: https://mamaye.org/blog/using-pupils-save-lives-mothers-and-babies-mchinji.
- Kapatuka, G. (2015). When bylaws prevent maternal and newborn deaths.
- https://www.healthynewbornnetwork.org/news-item/malawi-when-bylaws-prevent-maternal-and-newborn-deaths/.
- https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-018-0775-9#ref-CR2.
- https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-018-0775-9#ref-CR1.
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How to Cite
Anthony Masamba. (2024). A, Masamba Lived experiences and pathways to unsafe abortion among women and adolescents accessing post abortion care at selected hospitals in Lilongwe, Malawi: An interpretive phenomenological study. International Journal of Health, 11(1), 1-10. https://doi.org/10.14419/5n610p40